Abstract
BackgroundTrans-sacral epiduroscopic lumbar decompression (SELD) is an emerging procedure for the treatment of lumbar disc herniation (LDH), with favorable outcomes having been reported. However, the complications associated with SELD have not been comprehensively evaluated to date. Therefore, the aim of our study was to describe the incidence rate, types, and characteristics of complications following SELD and management outcomes.MethodsRetrospective analysis of the surgical and clinical outcomes for 127 patients (average age, 42.2 ± 15.2 years) who underwent SELD for LDH at L2-3, L3-4, L4-5, and/or L5-S1, performed by a single experienced spine surgeon at a single center, between January 2015 and April 2017, was conducted.ResultsAll procedures were successful, with a mean follow-up of 12.3 ± 2.3 months. Complications were identified in 8 patients (6.3%), including 3 cases of incomplete decompression (2.4%), 2 cases of recurrent disc herniation (1.6%), and one case each of hematoma, dural tearing, and subchondral osteonecrosis (0.8%). Among these cases with complications, only 2 cases with incomplete decompression and one case with recurrent LDH did not improve with conservative treatment and required re-operation using an open approach. The rate of complications decreased from 12.6% when considering only the first 50 cases to 2.6% for cases 51–127.ConclusionsIncomplete decompression, recurrent herniation, epidural hematoma, dural tear, and subchondral osteonecrosis were identified as complications of SELD, although the overall rate of complications was low. Practice with the procedure and careful patient selection can lower the risk of complications.
Highlights
Trans-sacral epiduroscopic lumbar decompression (SELD) is an emerging procedure for the treatment of lumbar disc herniation (LDH), with favorable outcomes having been reported
Treatment for LDH can be classified into microscopic open lumbar microdiscectomy (OLM) or a non-invasive pain-relieving procedure
SELD is useful for the treatment of a LDH at L5-S1, which is easy to access from the sacral hiatus because of the short distance from sacral hiatus to the L5-S1 intervertebral disc
Summary
Trans-sacral epiduroscopic lumbar decompression (SELD) is an emerging procedure for the treatment of lumbar disc herniation (LDH), with favorable outcomes having been reported. The underlying principle of SELD is to achieve sufficient decompression via laser vaporization of the nucleus pulposus, accessed through the sacral hiatus [4, 5] This technology has a unique advantage for the treatment of centrally located disc herniations and a LDH at the level of L5-S1. The aim of our study was to retrospectively evaluate the types, incidence, and characteristics of the complications of SELD performed for the treatment of LDH and to identify possible appropriate countermeasures to lower the risk for identified complications. This is the first study to evaluate the risks associated with SELD, information that will influence the ongoing development of SELD technology and methods, as well as support further exploration of the breadth of its application to the treatment of LDH
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